Percutaneous coronary intervention (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.

Related Key Words and Synonyms: Percutaneous Coronary Intervention, PCI, Balloon angioplasty, Percutaneous transluminal angioplasty

Overview

Coronary angioplasty is a procedure used to open blocked or narrowed blood vessels that supply blood to the heart. These blood vessels are called the coronary arteries. The procedure improves blood flow to the heart muscle.

Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow. This condition is called atherosclerosis. Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.

Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD. A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it that helps prevent the artery from closing.

Who needs coronary angioplasty?

• Coronary angioplasty is used to restore blood flow to the heart when the coronary (heart) arteries have become narrowed or blocked because of coronary heart disease (CHD).

• Angioplasty is one of a number of treatments for CHD. Other treatments include medicines and coronary artery bypass grafting (CABG). Your doctor will consider many factors when deciding what treatment or combination of treatments to recommend.

• Compared with CABG, some advantages of angioplasty are that it:

• Doesn't require an incision (cut)
• Doesn't require general anesthesia (that is, you won't be temporarily put to sleep during the procedure)
• Has a shorter recovery time

• Angioplasty also is used as an emergency procedure during a heart attack. As plaque builds up in the coronary arteries, it can rupture. This can cause a blood clot to form on the plaque's surface and block blood flow. The lack of oxygen-rich blood to the heart can damage the heart muscle.

• Quickly opening a blockage lessens the damage during a heart attack by restoring blood flow to the heart muscle. Angioplasty usually is the fastest way to open a blocked artery and is the best approach during a heart attack.

• A disadvantage of angioplasty, when compared with CABG, is that the artery more frequently renarrows over time. However, the risk of this happening is lower when stents are used, especially stents coated with medicines (drug-eluting stents).

• Stents are small mesh tubes that support the inner artery wall. They reduce the chance of the artery becoming narrowed or blocked again. Some stents are coated with medicines that are slowly and continuously released into the artery. The medicines help prevent the artery from becoming blocked again. However, stents aren't without risks. In some cases, blood clots can form in stents and cause a heart attack.

• Your doctor will talk to you about your treatment options and which procedure is best for you.

How is coronary angioplasty performed?

• Before the angioplasty procedure begins, you will be given some pain medicine. You may also be given blood thinning medicines to prevent a blood clot from forming.

• You will lie on a padded table. Your doctor will insert a flexible tube (catheter) through a surgical cut into an artery. Sometimes the catheter will be placed in your arm or wrist. You will be awake during the procedure.

• The doctor will use live x-ray pictures to carefully guide the catheter up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps the doctor see any blockages in the blood vessels that lead to your heart.

• A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart.

• A wire mesh tube (stent) may then be placed in this blocked area. The stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is left there to help keep the artery open.

• The stent may be coated with a drug (called a drug-eluting stent). This type of stent may lower the chance of the artery closing back up in the future. However, drug-eluting stents are slightly more likely to close in the short-term. Currently, they are only used for certain patients.

Why the procedure is performed?

• Arteries can become narrowed or blocked by deposits called plaque. Plaque is made up of fat and cholesterol that builds up on the inside of the artery walls. This condition is called atherosclerosis.

• Angioplasty may be used to treat:

• Blockage in a coronary artery during or after a heart attack
• Blockage of one or more coronary arteries that puts you at risk for a heart attack
• Persistent chest pain (angina) that medicines do not control

• Not every blockage can be treated with angioplasty. Some patients who have several blockages or blockages in certain locations may need coronary bypass surgery.

Where to find medical care that do angioplasty?

Directions to Hospitals Performing Angioplasty

What are the risks of angioplasty and stent placement?

Coronary angioplasty is a common medical procedure. Serious complications don't occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure.

Serious complications include:

• Bleeding from the blood vessel where the catheters were inserted.
• Blood vessel damage from the catheters.
• An allergic reaction to the dye given during the angioplasty.
• An arrhythmia (irregular heartbeat).
• The need for emergency coronary bypass surgery during the procedure (2–4 percent of people). This may occur if an artery closes down instead of opening up.
• Damage to the kidneys caused by the dye used.
• Heart attack (3–5 percent of people).
• Stroke (less than 1 percent of people).

• Sometimes chest pain can occur during angioplasty because the balloon briefly blocks blood supply to the heart.

• As with any procedure involving the heart, complications can sometimes, though rarely, cause death. Less than 2 percent of people die during angioplasty.

Complications from stents include:

• After angioplasty, the treated coronary artery can become narrowed or blocked again, often within 6 months of angioplasty. This is called restenosis.

• Studies suggest that there's a higher risk of blood clots forming in medicine-coated stents compared to bare metal stents. However, no conclusive evidence shows that these stents increase the chances of having a heart attack or dying, if used as recommended.

The risk of complications is higher in:

• People aged 75 and older
• People who have kidney disease or diabetes
• Women
• People who have poor pumping function in their hearts
• People who have extensive heart disease and blockages in their coronary (heart) arteries

What to expect before coronary angioplasty?

• Cardiologists do coronary angioplasties at hospitals. Cardiologists are doctors who specialize in diagnosing and treating heart diseases and conditions.

• If your angioplasty isn't done as an emergency treatment, you'll meet with your cardiologist before the procedure. He or she will go over your medical history (including the medicines you take), do a physical exam, and talk to you about the procedure.

• Your doctor also may recommend some routine tests, such as blood tests, an EKG (electrocardiogram), and a chest x ray.

• Once the angioplasty is scheduled, your doctor will advise you:

• When to begin fasting (not eating or drinking) before the procedure. Often you have to stop eating and drinking by midnight the night before the procedure.
• What medicines you should and shouldn't take on the day of the angioplasty.
• When to arrive at the hospital and where to go.

• Even though angioplasty takes only 1 to 2 hours, you'll likely need to stay in the hospital overnight or longer. Your doctor may advise you not to drive for a certain amount of time after the procedure, so you may have to arrange for a ride home.

What to expect after coronary angioplasty?

• After coronary angioplasty, you'll be moved to a special care unit. You'll stay there for a few hours or overnight. You must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely.

• While you recover, nurses will check your heart rate and blood pressure. They also will check your arm or groin for bleeding. After a few hours, you'll be able to walk with help.

• The place where the catheters (tubes) were inserted may feel sore or tender for about a week.

Going Home

• Most people go home the day after the procedure. When your doctor thinks you're ready to leave the hospital, you'll get instructions to follow at home, such as:

• How much activity or exercise you can do.
• When you should follow up with your doctor.
• What medicines you should take.
• What you should look for daily when checking for signs of infection around the area where the tube was inserted. Signs of infection may include redness, swelling, or drainage.
• When you should call your doctor. For example, you may need to call if you have shortness of breath; a fever; or signs of infection, pain, or bleeding where the tubes were inserted.
• When you should call 9–1–1 (for example, if you have any chest pain).

• Your doctor will prescribe medicine to prevent blood clots from forming after the procedure such as aspirin and clopidogrel (Plavix) or prasugrel (Efient). Taking your medicine as directed is very important. If you got a stent during angioplasty, the medicine reduces the risk that blood clots will form in the stent. Blood clots in the stent can block blood flow and cause a heart attack.

DO NOT STOP TAKING THEM WITHOUT TALKING TO YOUR DOCTOR FIRST. Stopping these medications too soon can be life-threatening.

Recovery and Recuperation

Most people recover from angioplasty and return to work about 1 week after leaving the hospital. Your doctor will want to check your progress after you leave the hospital. During the follow-up visit, your doctor will examine you, make changes to your medicines (if needed), do any necessary tests, and check your overall recovery.

Use this time to ask questions you may have about activities, medicines, or lifestyle changes, or to talk about any other issues that concern you.

Lifestyle Changes

Although angioplasty can reduce the symptoms of coronary heart disease (CHD), it isn't a cure for CHD or the risk factors that led to it. Making healthy lifestyle changes can help treat CHD and maintain the good results from angioplasty.

Talk with your doctor about your risk factors for CHD and the lifestyle changes you'll need to make. For some people, these changes may be the only treatment needed.

Lifestyle changes may include changing your diet, quitting smoking, doing physical activity regularly, losing weight or maintaining a healthy weight, and reducing stress. You also should take all of your medicines exactly as your doctor prescribes.

Cardiac Rehabilitation

Your doctor may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Your doctor can tell you where to find a cardiac rehab program near your home.

Outlook (Prognosis)

• For most people, angioplasty greatly improves blood flow through the coronary arteries and the heart. It may help you avoid the need for coronary artery bypass surgery (CABG).

• Angioplasty does not cure the cause of the blockage in your arteries. Your arteries may become narrow again.

• Follow your heart-healthy diet, exercise, stop smoking (if you smoke), and reduce stress to lower your chances of having another blocked artery. Your health care provider may prescribe medicine to help lower your cholesterol.

Video

Below is an animated video demonstrating angioplasty <youtube v=S9AqBd4RExk/>

Resources

National Heart Lung and Blood Institute

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